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Obama, Democrats show command of health care votes

Triumph in their grasp, President Barack Obama
and House Democrats demonstrated command of the votes needed to
pass landmark health care legislation Sunday night, a climactic
chapter in a century-long quest for near universal coverage.

The House argued its way through a thicket of Republican
objections toward a late-evening vote on the bill to extend
coverage to 32 million Americans who lack it, ban insurers from
denying coverage on the basis of pre-existing medical conditions
and cut deficits by an estimated $138 billion over a decade.

"Today is the day that is going to rank with the day we passed
the civil rights bill in 1964," said Rep. John Dingell of
Michigan, a member of Congress since 1955. "Today we're doing
something that ranks with what we did with Social Security or
Medicare. This is a day of which we can all be proud if we vote for
that legislation."

Republicans said it was nothing of the sort, warning of a
government takeover of the health care system, financed by a
trillion dollars in higher taxes and Medicare cuts combined.

"There is dirty deal after dirty deal after dirty deal in the
bill this House will vote on," said Rep. Mike Rogers of Michigan.
"It is a disgrace."

The measure cleared a critical early test vote, 224-206, a few
hours after Obama and Democratic leaders struck a compromise with
anti-abortion lawmakers whose votes had left the outcome in doubt.
The president issued an executive order pledging that no federal
funds would be used for elective abortion.

Rep. Bart Stupak, D-Mich., and a handful of fellow abortion
opponents said they were satisfied and announced their support for
the bill. A spokesman for the U.S. Conference of Catholic Bishops
expressed skepticism that the presidential order would satisfy the
church's objections.

Speaker PelosiCharles Dharapak/ASSOCIATED PRESS

A shouting band of protesters outside the Capitol dramatized
their opposition, and one man stood up in the House visitor's
gallery yelling, "Kill the bill" before he was ushered out -
evidence of the passions the tumultuous yearlong debate over health
care has stirred.

Passage of a central health care bill already cleared by the
Senate would send it to Obama for his signature. That still would
leave one more step, a companion package of changes would go to the
Senate.

For the president, the events capped an 18-day stretch in which
he traveled to four states and lobbied more than 60 wavering
lawmakers in person or by phone to secure passage of his signature
domestic issue. According to some who met with him, he warned that
the bill's demise could cripple his still-young presidency.

Far beyond the political ramifications - a concern the president
repeatedly insisted he paid no mind - were the sweeping changes the
bill held in store for millions of individuals, the insurance
companies that would come under tougher control and the health care
providers, many of whom would face higher taxes.

For the first time, most Americans would be required to purchase
insurance, and face penalties if they refused. Much of the money in
the bill would be devoted to subsidies to help families at incomes
of up to $88,000 a year pay their premiums.

Rep, Bart StupakHarry Hamburg/ASSOCIATED PRESS

The measure would also usher in a significant expansion of
Medicaid, the federal-state health care program for the poor.
Coverage would be required for incomes up to 133 percent of the
federal poverty level, $29,327 a year for a family of four.
Childless adults would be covered for the first time, starting in
2014.

The insurance industry, which spent millions on advertising
trying to block the bill, would come under new federal regulation.
They would be forbidden from placing lifetime dollar limits on
policies, from denying coverage to children because of pre-existing
conditions and from canceling policies when a policyholder becomes
ill.

Parents would be able to keep children up to age 26 on their
family insurance plans, three years longer than is now the case.

A new high-risk pool would offer coverage to uninsured people
with medical problems until 2014, when the coverage expansion would
go into high gear.

Passage of a central health care bill already cleared by the
Senate would send it to Obama for his signature as early as Monday.
That still would leave one more step, a companion package of
changes still needing Senate approval.

After more than a year of political combat - certain to persist
into the fall election campaign for control of Congress - Democrats
piled superlative upon superlative across several hours of House
debate.

Rep. Louise Slaughter of New York read a message President
Franklin Roosevelt sent Congress in 1939 urging lawmakers to
address the needs of those without health care, and said Democrat
Harry Truman and Republican Richard Nixon had also sought to
broaden insurance coverage.

Republicans attacked the bill without let-up, warning it would
harm the economy while mandating a government takeover of the
health care system.

"The American people know you can't reduce health care costs by
spending $1 trillion or raising taxes by more than one-half
trillion dollars. The American people know that you cannot cut
Medicare by over one-half trillion dollars without hurting
seniors," said Rep. Dave Camp, R-Mich.

"And, the American people know that you can't create an
entirely new government entitlement program without exploding
spending and the deficit."

Obama has said often that presidents of both parties have tried
without success to achieve national health insurance, beginning
with Theodore Roosevelt early in the 20th century.

The 44th president's quest to succeed where others have failed
seemed at a dead end two months ago, when Republicans won a special
election for a Massachusetts Senate seat, and with it, the votes to
prevent a final vote.

But the White House, House Speaker Nancy Pelosi, D-Calif., and
Senate Majority Leader Harry Reid, D-Nev. soon came up with a
rescue plan that required the House to approve the Senate-passed
measure despite opposition to many of its provisions, then have
both houses pass a fix-it measure incorporating numerous changes.

To pay for the changes, the legislation includes more than $400
billion in higher taxes over a decade, roughly half of it from a
new Medicare payroll tax on individuals with incomes over $200,000
and couples over $250,000. A new excise tax on high-cost insurance
policies was significantly scaled back in deference to complaints
from organized labor.

In addition, the bills cut more than $500 billion from planned
payments to hospitals, nursing homes, hospices and other providers
that treat Medicare patients. An estimated $200 billion would
reduce planned subsidies to insurance companies that offer a
private alternative to traditional Medicare.

The insurance industry warned that seniors would face sharply
higher premiums as a result, and the Congressional Budget Office
said many would return to traditional Medicare as a result.

The subsidies are higher than those for seniors on traditional
Medicare, a difference that critics complain is wasteful, but
insurance industry officials argue goes into expanded benefits.